But with change comes backlash and, sometimes, noisy condemnation. One such example is North Carolina Baptist Pastor Charles Worley, who made news headlines in May 2012 after a YouTube video of one of his sermons went viral. In it, he advocates concentration camps for homosexuals, preaching, “I figured out a way to get rid of all the lesbians and queers. Build a great, big, large fence fifty or a hundred miles long. Put all the lesbians in there. Fly over and drop some food. Do the same thing with the queers and the homosexuals. And have that fence electrified so they can’t get out. And you know what, in a few years they’ll die out. Do you know why? They can’t reproduce.”

Pastor’s Worley’s homophobic comments, although extreme, reflect the ideologies of some conservative Christians. Those same sentiments emerge in the regional context of what I call in my book, Pray the Gay Away: The Extraordinary Lives of Bible Belt Gays, as “Bible Belt Christianity.” Although there may be much wiggle room amongst individual Christians in their personal relationships with gay people, Bible Belt Christianity encourages both “compulsory Christianity”—communicative exchanges that involve presenting one’s Christian identity to others in routine social interactions—and the framing of homosexuality as sinful.

Fundamentalists like Pastor Worley interpret their beliefs within a total system that allows no shades of gray. For them, homosexuality is unsanctified, and those engaging in same-sex behavior are sinners. Cracking open their belief system a tiny bit to accommodate gay people means the dissolution of their religious structure, and the prospect of facing a great, cavernous unknowing about deep moral questions of good and evil, as well about the afterlife. While most conservative Christians would not promote violence against another person—like putting gay people in concentration camps—most do participate in religious groups that construct the behavior of an entire group of people as an abomination.

It is likely that Pastor Worley’s sermon was partly motivated by the anti-gay marriage amendment on the North Carolina ballot this past May. North Carolina was the latest state to pass an anti-gay marriage ballot amendment, and the last of the Bible Belt states to constitutionally amend one—Kentuckians successfully voted to ban same-sex marriage during the 2004 presidential election season. The Bible Belt gays featured inmy book spoke extensively about the heartache and divisiveness caused by anti-gay ballot amendments. For a gay person, seeing political ads, billboards, newspaper op-eds, and lawn signs announcing a homophobic opinion on gay rights is extremely stressful. While an anti-gay lawn sign is not personally directed against any specific individual, running across them is still intimidating and distressing for a gay person, and can be perceived as a justification of homophobic attitudes in those who, like Pastor Worley, hold them. But what has shifted since 2004—and what is deserving of our appreciation this Pride month—is how homophobic comments like those of Pastor Worley are interpreted in public conversations in major media outlets and on social networking sites.

First of all, gay issues are covered today. Every other day it seems—and, sometimes every day—there is a new story on gay rights. Second, homophobic speech, like the sermon Pastor Worley gave, draws much condemnation. Rather than passing it as “business-as-usual, of course it’s disgusting—we don’t even need to talk about it,” people, even in the Bible Belt, are noticing and talking about the injustices gay people face. And, finally, arguments against same-sex marriage—like the ones that the conservative Christian group American Family Association makes about how allowing people of the same sex to marry opens the door for people to marry their dog, horse or cousin—sound even more ludicrous in 2012, because, well, how would a dog sign a legal contract?

Bible Belt gays are uniquely positioned to observe gradual improvements in homophobic attitudes. On the front lines of the culture wars in the United States, Bible Belt gays have hard-won insights to share with gay people from more politically progressive regions of the United States. It’s not only because the lives of Bible Belt gays illustrate the maxim—having endured much, they are stronger for it—but because the personal work required of gay people in the Bible Belt to line up with each other in the face of preachers like Charles Worley makes them more powerful and independent. As Terry, a 29-year-old white lesbian from eastern Kentucky explained, “We speak fundamentalist Christianity. We are interpreters and liaisons. We know that fundamentalists are not crazy. They are wrong. And there is a difference.”

The good part about framing conservative Christians as “wrong” instead of “crazy” is that wrong is more malleable. Pastor Worley may not easily recognize the “wrongness” intrinsic to his belief system, but many other Bible Belt Christians are slowly changing their perceptions of homosexuality. As gay issues continue to get press, as gay people and same-sex relationships are represented in positive ways in the media, as gayness itself becomes more familiar—even for the rural heterosexual who may have never met an openly gay person—we as a culture are getting more used to gay life. And that is something worth celebrating.

Bernadette Barton is Professor of Sociology and Women’s Studies at Morehead State University in Morehead, Kentucky. She is the author Stripped: Inside the Lives of Exotic Dancers (NYU Press, 2006) and Pray the Gay Away: The Extraordinary Lives of Bible Belt Gays, to be released by NYU Press in October 2012.

What NPH (and my new book on gay fatherhood) can teach us about gay parenting

By Abbie E. Goldberg

Photo: George Burns

In their recent interview with Oprah, Neil Patrick Harris and his partner David Burtka opened up about parenthood, surrogacy, and raising twins. As Harris emphasized in his interview, “We really, really wanted kids. We really had thought it through financially, emotionally, relationship-wise. We didn’t just accidentally get pregnant and decide that now we need to make this work. These kids come into our world with nothing but love.” Oprah then admitted to an “aha” moment, wherein she realized, “The children [of gay parents] are so loved!”

The topics that Harris and Burtka touched on in their interview with Oprah – who came to their house – intersect with many of the issues that I address in my new book, Gay dads: Transitions to adoptive fatherhood, which will be published by NYU Press in July 2012. As Harris alluded to, the process of deciding and then becoming a parent as a gay man is one that is highly intentional. The 70 gay men whom I spoke to emphasized the numerous decisions involved in pursuing parenthood, including: How should they become parents – adoption, surrogacy, or some other route? If they should pursue adoption, what type of adoption (private domestic, public domestic, international) should they pursue? Who would be the legal adoptive parent (for those living in states that did not allow gay male couples to co-adopt)? How would they tell their parents and families about their decision to become parents? Should they seek out female role models for their child? Should they move to a more progressive, gay-friendly area?…and the list goes on and on.

Harris and Burtka also discussed the challenges that Harris encountered in bonding to his twins early on. Like some of the couples whom I interviewed, Harris and Burtka had different comfort levels with infants, with Burtka expressing greater ease and comfort with infant caregiving, and Harris acknowledging greater perceived aptitude at dealing with and parenting older children. As I discuss in my book, gay parents – like all parents – may be differentially attached to their children early on, with one partner bonding more readily to the child(ren) than the other. These differential attachment patterns may be related to the division of labor (i.e., who is home more; who is doing more child care), parents’ personalities, children’s personalities, and a variety of other factors.

Harris and Burtka also talked about their different “roles,” particularly in the initial stages of parenting. Burtka was home more, while Harris worked more (on his hit TV show, How I Met Your Mother). Thus, their foci (caregiving and breadwinning) were somewhat different during early parenthood. This pattern is not unusual in gay or heterosexual couples; as I discuss in my book, in about half of the 70 couples whom I interviewed, one partner worked part-time or stayed home while the other partner worked full-time. Those who took on different roles in relation to providing and caregiving described both challenges and benefits of their arrangement. For example, in some cases couples worried that the child would become more bonded to the partner who was home more; yet on the other hand, they were grateful that they could afford to have a parent at home, at least part-time, and thereby minimize their reliance on outside child care.

Neil Patrick Harris and David Burtka’s interview with Oprah underscores the main message of the book: Gay parents are, as Burtka states, “the new nuclear family.” In this way, their experiences are, in many ways, similar to those of the heterosexual parents – but yet their experiences are also uniquely shaped by their relational status as two men, their minority status in society, and the continued pervasiveness of societal heterosexism.

But, with new challenges come new opportunities. Healing the Broken Mind: Transforming America’s Failed Mental Health System by Timothy A. Kelly (2009) not only makes the case for use of clinical outcome measures to create more efficient care, but shows how the resultant data will improve quality of care and quality of life for those seeking help. Kelly argues that the time has come for a sweeping transformation of mental health care so that recovery becomes the norm. The book provides a realistic road map for getting there – addressing both policy and clinical concerns in a thoughtful and comprehensive manner.

Kelly himself thinks that making some hard choices about mental health care may be a good thing. “As the nation struggles to overcome deficits and pull out of a stagnant economy, expensive medical services are potentially on the chopping block – including mental health care,” he wrote in an e-mail. “Third party payers – federal, state and private insurers – are asking which services are most effective and which, if any, are not. The only way to answer such questions is to track the actual outcomes of clinical care. This means the time has come for mental health service providers to begin collecting outcome data so as to support the value of their particular treatment approach. Those who can demonstrate effectiveness will have a much easier time of maintaining funding than those who cannot.”

After receiving a grant from the Mountain Plains Equity Group, NAMI Montana has spent the last year trying to bring a comprehensive, real-time outcomes measurement program to analyze Montana’s state-funded mental illness treatment system. The program was inspired by system transformation guidelines set out in Healing the Broken Mind: Transforming America’s Failed Mental Health System by Dr. Timothy Kelly. We are happy to announce that mental health centers around the state are slowly beginning to buy into the program.

“Perhaps the current fiscal crisis can spur sweeping reforms that are long overdue in mental health services,” says Kelly. “If so, then the agony of budget cuts may at least lead to something positive in the long run – better care.”

And so they gather, these strange, familiar creatures in their ever-shifting habitat. Traveling in flocks and packs, they eye one another warily, constantly, checking out their plumage and song, finally turning to the puzzling creature reflected in the glass to gauge where in the pecking order they stand. And if that reflection falls short of what they had envisioned, if the collective gazes prove too withering, they fly off, by themselves, crests fallen …

We know them, and yet we don’t know them. Though they feed at our table, and accept our shelter, they ignore us as much as they can; we are, for all intents and purposes, irrelevant. Yet we regard them with powerful affection, as well as bemusement and exasperation. After all, we were once those strange birds, and we know how fickle, even cruel, the species can be. And while they may not realize it, or want to admit it, they are slowly evolving into something like us.

It is the adolescent dialectic, and it is an inexorable force.

“When adolescence starts, there’s an imperative that begins to operate,” Vivian Center Seltzer SW’53, professor emerita of human development and behavior in the School of Social Policy and Practice (SP2), is saying. “It’s an imperative to be together—a growth-related imperative. And when they are together, then this whole big process goes into subliminal action. There’s a force that becomes ignited. That force is psychological growth, and it’s ignited by the electricity of the comparison behavior that goes on between them.”

In this year of debate over healthcare reform, a former state mental health commissioner shares his 30 years of experience to describe the failings of mental health care in the United States and to advocate a major overhaul. Kelly is a former commissioner of Virginia’s Department of Mental Health, Mental Retardation and Substance Abuse Services. His experience in the workings of state institutions and outpatient service-providers is eye-opening and lends support to his proposals for reform.

The book includes statistics to bolster his arguments, but the most influential material comes from his descriptions of real families trying to get help for desperately ill and misunderstood loved ones. He describes the problems of over-medication, poor insurance coverage and behind-the-scenes incompetence among staff in mental health facilities. The book also focuses on the much-discussed notion of parity in mental health treatment and the loopholes in parity laws that are barriers to treatment.

Kelly, currently director of the DePree Public Policy Institute, does not suggest that more money will fix the system. “The status quo is broken,” he writes. What is needed is funding to create a new system of outcome-oriented, community-based services that is both innovative and accountable. It’s a tall order, but Kelly makes a good case for giving it our best shot.

In the 1960s, a movement called “antipsychiatry” (prompted in Britain by R. D. Laing and in the U.S. by Thomas Szazs) questioned the basic assumptions about mental illness and its treatment. Not only psychiatry, but methods popular earlier in the twentieth century, such as the prefrontal leucotomy, electroconvulsive therapy (ECT), and insulin coma therapy, lay thoroughly discredited. The anti-psychiatrists encouraged treating the patient as a whole person, putting his “madness” in the social and environmental context. Unfortunately, with the passage of the counterculture the medical establishment returned with a vengeance to explaining mental illness strictly as a manifestation of physical disorders of the brain and treating it with particular medications.

Dr. Richard P. Bentall, professor and practitioner of clinical psychology in Britain, who earlier wrote Madness Explained: Psychosis and Human Nature (2003), exposes the highly dubious nature of reigning presumptions about the causes and treatment of mental illness. He favors the “recovery-oriented, autonomy-promoting” model, particularly cognitive behavioral therapy, over the “paternalistic-medical” model, which favors reductionist diagnosis, genetic causation, and reliance on drugs to correct so-called “chemical imbalances.” Bentall explores why the biomedical approach has become dominant, instead of a social approach to madness, which was gaining traction in the 1960s. There is little evidence to show that psychiatric drugs are effective in the long run; by making spurious connections between damaged brains and drugs alleged to overcome such disfigurement, the medical profession ignores better treatment options.

“For too many Americans with mental illness, the mental health services they need remain fragmented, disconnected and often inadequate, frustrating the opportunity for recovery…. [and adding] to the burden of mental illnesses for individuals, their families, and our communities.” Those were the words of the President’s New Freedom Commission on Mental Health (2003), which went on to recommend “a fundamental transformation of the nation’s approach to mental health care.”

That transformation has not yet occurred. As a former mental health commissioner and practicing psychologist, I have seen too many heart-breaking examples of people with mental illness who long to recover, but spend a lifetime seeking effective care. There are many good mental health providers across America, but not enough. Furthermore, the system (e.g., reimbursement structures and vested interests) fights against anything that challenges the status quo.

Amy Farrell, contributor to The Fat Studies Reader and author of a forthcoming NYUP book called Fat Shame, took her message to the Colbert Report last night. Developing what she and the volume editors had started in separateappearances on the Brian Lehrer Show, she drove home the need to distance overweight from poor health, and described the myriad cultural and professional obstacles fat people face.

Stephen Colbert was his usual whip smart and hilarious self on the set, but also gracious and engaging backstage. (Also in the green room was The RZA, there to talk about his new book during the last segment, thus joining Amy and The RZA for video eternity!)

–Eric Zinner, Editor-in-Chief

P.S. A special shout out to Emily Lazar and Amy Schwartz of the Colbert Report for recognizing the importance of the issue and Amy’s talent, and making everything go so well while we were there.

What prompted you to write “Healing the Broken Mind”?
Thirty years in the mental health field. But the capstone of that was my serving as Commissioner of Virginia’s Department of Mental Health from 1994-97. As Commissioner I saw things most people don’t see. For instance, I would make surprise visits to psychiatric facilities across the state, where I found that the care being provided was closer to custodial care [“a fancy term for babysitting,” explains Kelly]—than anything else.

While there were programmed activities—on paper, at least—I often found staff and patients alike lounging around on couches watching TV, waiting for the patients’ meds to kick in. And once their meds kicked in and they were stabilized, they would be discharged into the community. They would be given minimal follow-up care, usually a once-a-month meds check. So they would eventually spiral down and deteriorate and be readmitted to the hospital—a vicious cycle that is very costly, both for the individual on a personal level and for the state on a financial level. Seeing that over and over again lit a fire in me. I’ve been speaking and writing about mental health reform ever since.

Why is the U.S. mental health care system in such bad shape?
[In the mid-20th century] America went through an institutionalization process where we built facilities to house individuals with serious mental illness. In the 1950s, at the height of that era, we had over 500,000 people hospitalized. Then we discovered that is not the best way to treat mental illness. If you put someone in an institution and leave them there for a long time that person will become institutionalized, and it becomes difficult for them to live on the outside, even if their mental illness remediates.

So in the 1950s and ’60s a public policy decision was made to deinstitutionalize. It was the right policy, but it wasn’t implemented correctly. It requires flexible home- and community-based care, so that when patients are discharged they go home not to minimalistic care, but to creative, energetic services that are available as needed. That might include somebody coming by the house and helping out, or coming by late at night for a meds check, or helping with a problem at work. In other words, whatever it takes so that person can live successfully in their community, with a home, a job, and good relationships. That’s what is needed, and it is doable.

Richard Bentall, a clinical psychologist, is a controversial figure in the field of mental health. An example of the hostility that his conclusions provoke among those practising conventional (that is, drug-based) psychiatry is given in the preface to this book, which raises serious questions about the treatment of mental illness. Bentall describes an encounter with an amiable-seeming psychiatrist who responds to a talk he has given as follows: “Professor Bentall has told us he is a scientist. But he is not! Nothing that Professor Bentall has said – not one single word – is true.”

he unlikelihood of a professor of psychology delivering, in the sober environment of an NHS conference, a talk in which every word is fictitious and every opinion fallacious gives a flavour of the threat that Bentall’s theories pose. The response, as reported, sounds deranged and it is interesting to observe how debate among professionals over the causes of mental illness appears to induce its own version of madness, as if the topic itself were contagious. One sign of sanity, both in the individual and society, is the ability to deal with dissent.

In an earlier book, Madness Explained, Bentall was at pains to distinguish his approach from other anti-psychiatrists – for example, RD Laing, whose radical views were discredited because of his flamboyant lack of rigour and attendant inability to accept criticism. Bentall, as this book attests, is a different kettle of fish. With patient persistence and without recourse to rancorous diatribes, he has appraised the scientific evidence for the success of contemporary psychiatric treatments and come up with a dismal report. It is probably the very balance of his approach that drives his opponents crazy.

Doctoring the Mind is an attempt to clarify the dense array of evidence offered in Bentall’s earlier work. The result is a much easier read. It is also, for that reason, more disturbing. Other recent books (Lisa Appignanesi’s Mad, Bad and Sad, for example) have also traced the dark strains of misperception, mismanagement and downright cruelty in psychiatry’s chequered history, but Bentall’s achievement is to focus on contemporary psychiatric practices, especially those dedicated to treating serious psychoses (his own area of expertise).

Read the rest of the article here. More coverage of the book here and here.